NHS Constitution

BG: Average 6.1; 7 Day Average 6.6; 14 Day Average 6.6; 28 Day Average; 6.7; Cigarettes 1; Wine 0 Glasses;

Yesterday I travelled up to London for a session organised by Diabetes UK to discuss the draft NHS constitution. I don’t think I’ve met a nicer bunch of people. This is a copy of a post I made on the www.diabetes.co.uk forum.

Apologies for the length of the posting, but this is something I feel very passionate about. Draft constitution information can be found here and the reason for publishing one is so that the patients and staff have all their rights and responsibilities in one place. The constitution is one of the reforms suggested by Lord Darzi.

Taken at face value it is a very laudable document and covers the rights and responsibilities of both patients and staff – though there are some concerns over the language used. The constitution differentiates between what is a right and what the document calls a pledge, that which the NHS aspires to provide. I was concerned to see that the NHS can only pledge the following:

The NHS will strive to ensure that services are provided in a clean and safe environment that is fit for purpose, based on national best practice.

The document does not differentiate between national strategies and local problems. In instances, like diabetes, which both the NHS and press call a national problem, but which is treated as a local issue hence the postcode lottery regarding some of the treatment we all receive. The constitution stresses the local nature of treatment, which is right for local issues but isn’t for a problem like diabetes where treatment must be, IMO, of a consistent quality throughout England with the following weasel phrases:

You have the right to drugs and treatments that have been recommended by NICE for use in the NHS, if your doctor says they are clinically appropriate for you.

You have the right to expect local decisions on funding of other drugs and treatments to be made rationally following a proper consideration of the evidence. If the local NHS decides not to fund a drug or treatment you and your doctor feel would be right for you, they will explain that decision to you.

Another point that was raised yesterday was that the document does not cover the individuality of all of us, for instance, the NHS play book for type 2s is that we should be prescribed a statin, whether or not we need one. I’ve been on 20mg Simvador since diagnosis, my GP has instructed me to double that, because regardless of the fact that my lipid profile has been perfectly satisfactory since a month after diagnosis,

that’s what the guidelines say.

During yesterdays discussions it was recognised that, with reference to the first patient responsibility

You should recognise that you can make a significant contribution to your own, and your family’s, good health, and take some personal responsibility for it.

there are at least three types of diabetics:

• Those in denial;
• Those who will just follow guidance;
• Those of us who take an interest in our condition.

very often our HCPs lump everyone together – expecting more from some of us, and disregarding the input of those who actually want to participate in a treatment plan. This is a particular bugbear of mine:

You should treat NHS staff and other patients with respect and recognise that causing a nuisance or disturbance on NHS premises could result in prosecution.

but this isn’t reciprocated it is not a patient right to be treated with respect nor is it a staff responsibility – so they can be as rude to us as they like, and we just have to accept it with a stiff upper lip – errrr, no.

There are concerns over how much it will cost to produce and distribute both the constitution and the patients handbook.

Still, yesterday was a consultation, and the DUK team left with a lot of words, some of which were in some semblance of an order, to send back to the DH (hopefully in the same order). I really did feel as if we were being listened to (there was a DH representative there for the first part of the day). I would like to congratulate DUK on what was a well organised, if quickly convened, day.

First Great Western proved really surprising – the 6:25 from Worcester was cancelled

Today I have an appointment with a dietitian, it’s taken since the end of June to eventually get to see one, rarer than rocking horse doo-doo apparently.

Too much Government

BG: Average 6.6; 7 Day Average 6.6; 14 Day Average 6.7; 28 Day Average; 6.9; Cigarettes 2; Wine 2 Glasses;

This caused me to cringe. Ms. Tubs has just turned 11 and I can’t think of a single occasion when either Mrs. Tubs or I have had to use any form of physical punishment against her in order to enforce a lesson. We just don’t see it as a viable piece of parenting strategy, but that’s us. I do think there is a limit to the state’s involvement with the family and the notion that anti-spanking legislation is helpful definitely impinges upon that limit. The state should be involved in promoting family well-being and not involving itself in the management of the family. What next? State prescribed pocket money? This sort of legislation helps no-one, how will it be enforced? My father physically abused me, sending me, on a number of occasions, to school covered in bruises – teacher’s reaction – nothing, the only reason the state didn’t get involved was because my father restrained himself and didn’t injure me seriously enough to warrant a hospital visit.

On the one hand the state expects parents to be responsible for their children’s behaviour (fines for truancy, fines for anti-social behaviour, fines ad nauseum) and yet is determined to strip the ways and means of controlling those for whom we are responsible away from us. The House of Lords (JD v East Berkshire Community Health NHS Trust, 21 April 2005) have ruled that parents cannot sue either the NHS or Social Services if wrongly accused of abuse, yet being wrongly accused of abuse must inevitably have some impact on the family. Paradoxically, children can sue the NHS or Social Services if their parents are wrongly accused of abuse. So, all it will take, is one p*s!ed off teenager, who “knows his rights”, to complain and the parents lives are ruined, and it has happened…in Manchester.

Tomorrow I’m travelling up to London to take part in an NHS Constitution consultation panel.

Things which made me smile today

BG: Average 6.1; 7 Day Average 6.7; 14 Day Average 6.7; 28 Day Average; 6.9; Cigarettes: 0; Wine: 1 Glass;

Apparently some Church of England vicar has written a blog calling for all gays to be tattooed.

Osborne claims that, at a recent social event, Mandelson spent a significant amount of time whinging about Brown…his new boss.

Mandelson gets rushed to hospital on the first day of his new job.

NASUWT general secretary claims that it is an anomaly that a teacher who has had sex with a pupil aged over 16 could go on the sex offenders register…except of course the sex offenders register was put in place to prevent abuse of position.

There’s going to be a fourth Pirates of the Caribbean.

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21:30 Having a second glass of wine tonight whilst watching Run, Fat Boy, Run which is also making me smile.

The Prince of Darkness Returns

BG: Average 7.0; 7 Day Average 6.8; 14 Day Average 6.8; 28 Day Average; 7.1; Cigarettes: 0; Wine: 3 Glasses;

Mandelson returns to government! Who’d have thought it? The guy is forced to resign from government on two different occasions and Gordon Brown hands him a cabinet position.

First, Mandelson should have little or no credibility with the British electorate. Does our PM really think the electorate are so stupid as to forget the Dome fiasco, Mandelson’s lying on his mortgage application form and the lies about his involvement with the Hinduja brothers’ passport application. This smacks of desperation and of a beleaguered PM ensuring his Blairite enemies don’t launch a plot to oust him before the next general election.

Secondly, before he takes up his cabinet position he will have to be appointed to the House of Lords, this from a political party who’s aim is to make the House of Lords a democratically elected chamber. Hey ho, needs must as the devil drives eh?

Mandelson’s appointment to cabinet and the return of Campbell indicate that NuLabour has given up the ghost of being straight with the British public and signifies a return to the bad old days of post 1997 when the British electorate were lied to time and time again just to make the government of the day look good.